Thirty-eight fatigue fractures of the femoral shaft in thirty-five patients are reported on and analyzed. All but one occurred in young men undergoing the first eight weeks of basic military training. The other case was that of a seventeen-year-old youth, who was training for track. The right femoral shaft was involved in thirty fractures and the left in eight; three patients had bilateral fractures. Sixteen fractures were displaced and twenty-two were undisplaced.
The most frequently encountered symptom was pain in the knee or thigh with activity. Even when the fatigue reaction or fracture was located in the upper part of the femur, symptoms were often referred to the knee.
The most important aspect of treatment is early recognition in order to prevent displacement. For accurate diagnosis, an awareness of the possibility of such a fracture and complete roentgenograms of the femur are essential in patients in whom such a fracture is suspected and who complain of knee pain.
Results of treatment have been satisfactory in both the displaced and undisplaced fractures. In undisplaced fractures, curtailment of physical activity by means of bed rest or use of crutches is necessary, depending on the severity of symptoms and roentgenographic appearance. Skeletal traction generally is adequate for treatment of displaced fractures, but, on occasion, open reduction and internal fixation may be employed, depending on the amount of comminution and degree of displacement.
From the U.S. Army Hospital, Fort Ord Infantry Training Center, Fort Ord, California, and the Department of Orthopaedic Surgery, University of California School of Medicine, San Francisco